Discharge Cognitive–Motor Imbalance Patterns and Long-Term Outcomes After Traumatic Brain Injury: A Propensity Score-Matched Cohort Study

Background/Objectives: Traumatic brain injury (TBI) often results in heterogeneous recovery across cognitive and motor domains. However, the prognostic implications of motor–cognitive imbalance at the time of rehabilitation discharge remain unclear. This study investigated whether discharge patterns of motor–cognitive imbalance are associated with functional outcomes at 1- and 2-year follow-up in individuals with moderate-to-severe TBI. Methods: We conducted a retrospective cohort study using the Traumatic Brain Injury Model Systems (TBIMS) National Database. Adults discharged from inpatient rehabilitation with available Functional Independence Measure (FIM) motor and cognitive subscores were included (n = 8342). Participants were classified as cognitive-dominant, motor-dominant, or balanced based on standardized discrepancies between FIM motor and cognitive scores. Propensity score matching was performed against the balanced group, yielding a matched cohort of 1310 participants. Outcomes included the Disability Rating Scale (DRS), FIM (total and subscales), Glasgow Outcome Scale—Extended (GOSE), and Participation Assessment with Recombined Tools—Objective (PART-O) at 1 and 2 years. Results: The matched cohort included cognitive-dominant (n = 524), motor-dominant (n = 524), and balanced (n = 262) participants with good covariate balance. Compared with the balanced group, the cognitive-dominant group showed lower disability severity (DRS) at 1 year (β = −0.45; 95% CI, −0.81 to −0.09) and 2 years (β = −0.40; 95% CI, −0.78 to −0.03), and higher FIM total scores at both time points. The motor-dominant group demonstrated higher FIM motor scores but lower odds of favorable disability status (DRS ≤ 3) at 2 years (OR = 0.52; 95% CI, 0.31–0.88). GOSE and PART-O outcomes did not differ significantly across groups. Conclusions: Discharge motor–cognitive imbalance patterns were associated with modest but distinct differences in long-term disability severity and functional independence after moderate-to-severe TBI. The direction of imbalance may provide additional prognostic context beyond total functional scores and support domain-targeted post-acute rehabilitation planning.